Medicaid’s Role in Kentucky

Medicaid in Kentucky

More than 1.2 million people in Kentucky are covered by Medicaid (22% of the total population). While seven in ten (74%) enrollees are children and adults, more than half (53%) of the state’s Medicaid spending is for the elderly and people with disabilities.

40% of all children in Kentucky are covered by Medicaid, including 52% of children with special health care needs.

19,149 nursing home residents in Kentucky (67% of total nursing home residents) arecovered by Medicaid and 49% of Medicaid long-term care spending in Kentucky is for nursing home care. Medicare beneficiaries rely on Medicaid for assistance with services not covered by Medicare, particularly long-term care.

Nearly one-half (49%) of people in Kentucky live in rural areas, which is higher than the national average of 19%. People who live in rural areas are more likely to be covered by Medicaid.

91% of Medicaid enrollees in Kentucky arein managed care. Since Kentucky has already transitioned most enrollees to managed care, it would not be able to recoup the one-time savings that some states experience during that transition.

Kentucky has a low per capita income and therefore a relatively high federal Medicaid matching assistance percentage (FMAP) at 70.5%. For every $1 spent by the state, the Federal government matches $2.39. Nearly two-thirds (64%) of all federal funds Kentucky receives are for Medicaid. In Calendar Year 2017, the federal match rate for the Medicaid expansion population is 95%.

What is at Risk under a Per Capita Cap?

Capping Medicaid funding would reduce the federal assistance for Kentucky to maintain its current Medicaid program.

Under the Better Care Reconciliation Act of 2017 (BCRA), to maintain its current Medicaid program, Kentucky would have to make up $11.6 billion in loss of federal funds between 2020-2029, including $6.6 billion for the phase-out of the enhanced match for the ACA expansion and $5 billion for the per enrollee cap on all groups.

If Kentucky dropped the Medicaid expansion in response to the loss of enhanced federal financing, the state would forgo an additional $29.9 billion over the 2020-2029 period, and by 2029, 557,000 Kentuckians estimated to be covered in the expansion group would lose Medicaid coverage.

Capping federal Medicaid funding could put Medicaid programs designed to improve quality of life and access to new therapies and long-term care for people with disabilities at risk. 17% of Kentucky’s non-institutionalized population reported a disability, the fourth highest state reported percentage compared to a U.S. average of 13%.

Reducing federal funds through a per capita cap or block grant would limit Kentucky’s ability to respond to public health crises such as the opioid epidemic, HIV, or Zika.

Kentucky ranks 6th for the highest rate of opioid deaths at 21 deaths per 100,000 population in 2015.

Kentucky ranks 45th in overall health status. In addition, 23% of Kentucky’s population live in a health professional shortage area for primary care and have limited access to the services they need while 12% of adults report not seeing a doctor due to cost.